Medical Tourism

Medical tourism (also called medical travel, health tourism or global healthcare) is a term initially coined by travel agencies and the mass media to describe the rapidly-growing practice of traveling across international borders to obtain health care. Such services typically include elective procedures as well as complex specialized surgeries such as joint replacement (knee/hip), cardiac surgery, dental surgery, and cosmetic surgeries. However, virtually every type of health care, including psychiatry, alternative treatments, convalescent care and even burial services are available. As a practical matter, providers and customers commonly use informal channels of communication-connection-contract, and in such cases this tends to mean less regulatory or legal oversight to assure quality and less formal recourse to reimbursement or redress, if needed.

Over 50 countries have identified medical tourism as a national industry. However, accreditation and other measures of quality vary widely across the globe, and there are risks and ethical issues that make this method of accessing medical care controversial. Also, some destinations may become hazardous or even dangerous for medical tourists to contemplate.

The concept of medical tourism is not a new one. The first recorded instance of medical tourism dates back thousands of years to when Greek pilgrims traveled from all over the Mediterranean to the small territory in the Saronic Gulf called Epidauria. This territory was the sanctuary of the healing god Asklepios. Epidauria became the original travel destination for medical tourism.

Spa towns and sanitariums may be considered an early form of medical tourism. In eighteenth century England, for example, patients visited spas because they were places with supposedly health-giving mineral waters, treating diseases from gout to liver disorders and bronchitis.

Factors that have led to the increasing popularity of medical travel include the high cost of health care, long wait times for certain procedures, the ease and affordability of international travel, and improvements in both technology and standards of care in many countries.

Medical tourists can come from anywhere in the First World, including Europe, the Middle East, Japan, the United States, and Canada. This is because of their large populations, comparatively high wealth, the high expense of health care or lack of health care options locally, and increasingly high expectations of their populations with respect to health care.

A large draw to medical travel is convenience and speed. Countries that operate public health-care systems are often so taxed that it can take considerable time to get non-urgent medical care. Taking Canada as an example, an estimated 782,936 Canadians spent time on medical waiting lists in 2005, waiting an average of 9.4 weeks. Canada has set waiting-time benchmarks, e. g. 26 weeks for a hip replacement and 16 weeks for cataract surgery, for non-urgent medical procedures. In Costa Rica, Singapore, Hong Kong, Thailand, Cuba, Colombia, Philippines or India, a wealthy patient could feasibly have an operation the day after their arrival, while the poor may die before they receive help.

The cost of surgery in India, Thailand or South Africa can be one-tenth of what it is in the United States or Western Europe, and sometimes even less. A heart-valve replacement that would cost $200,000 or more in the US, for example, goes for $10,000 in India - and that includes round-trip airfare and a brief vacation package. Similarly, a metal-free dental bridge worth $5,500 in the US costs $500 in India, a knee replacement in Thailand with six days of physical therapy costs about one-fifth of what it would in the States, and Lasik eye surgery worth $3,700 in the US is available in many other countries for only $730. Cosmetic surgery savings are even greater: a full facelift that would cost $20,000 in the US runs about $1,250 in South Africa.

Popular medical travel worldwide destinations include: Argentina, Brunei, Cuba, Colombia, Costa Rica, Hong Kong, Hungary, India, Jordan, Lithuania, Malaysia, The Philippines, Singapore, South Africa, Thailand, and recently, Saudi Arabia, UAE, Tunisia and New Zealand. In Europe Belgium, Poland and Slovakia are also breaking into the business.

The typical process is as follows: the person seeking medical treatment abroad contacts a medical tourism provider. The provider usually requires the patient to provide a medical report, including the nature of ailment, local doctor’s opinion, medical history, and diagnosis, and may request additional information. Certified medical doctors or consultants then advise on the medical treatment. The approximate expenditure, choice of hospitals and tourist destinations, and duration of stay, etc., is discussed. After signing consent bonds and agreements, the patient is given recommendation letters for a medical visa, to be procured from the concerned embassy. The patient travels to the destination country, where the medical tourism provider assigns a case executive, who takes care of the patient's accommodation, treatment and any other form of care. Once the treatment is done, the patient can remain in the tourist destination or return home.

Music tourism is the act of visiting a city or town, in order to see a gig or festival. With the presence of the tourist, money is spent and the local economy benefits. This sort of tourism is particularly important to small villages such as Glastonbury, as well as large cities like Glasgow.

Music tourism is one of the newest typology of tourism. Music tourism can be categorized under pleasure tourism, as it involves travel of people to watch a music concert. Rock music and hip-hop music are the two main genre of music which create music tourism.

Nautical tourism is an increasingly popular way to combine love of sailing and boating with vacation and holiday activities. First defined as an industry segment in Europe and South America, it has since caught on in the United States and the Pacific Rim.

Not only is nautical tourism an enjoyable way to see unique parts of the world, it is also a very profitable industry. Many tourists who enjoy sailing combine water travel with other activities. Supplying the equipment and accessories for those activities has spawned businesses for those purposes. With many nautical enthusiasts living onboard their vessels even in port, nautical tourists bring demand for a variety of goods and services. Marinas developed especially for nautical tourists have been built in Europe, South America and Australia.

Tourist services available at marinas catering to nautical tourists include:

• leasing of berths for sailing vessels and nautical tourists who live onboard;

• leasing of sailing vessels for holiday and recreational use (charter, cruising and similar);

• reception, safe-guarding and maintenance of sailing vessels;

• provision of stock (water, fuel, supplies, spare parts, equipment and similar);

• preparation and keeping sailing vessels in order;

• providing information to nautical enthusiasts (weather forecasts, nautical guides etc.);

• leasing of waterscooters, jetskis, and other water equipment.

Overland travel or overlanding refers to an "overland journey" - originating with Marco Polo's first overland expedition in the 13th century from Venice to the Chinese court of Kublai Khan. Today overlanding is a form of extended adventure holiday, embarking on a long journey, often in a group. Overland companies provide a converted truck or a bus plus a tour leader, and the group travels together overland for a period of weeks or months.

Since the 1960s overlanding has been a popular means of travel between destinations across Africa, Europe, Asia (particularly India), the Americas and Australia. The "Hippie trail" of the 60s and 70s saw thousands of young westerners travelling through the Middle East to India and Nepal.

Rail Overland Travel

At 9,288km the Trans-Siberian Railway is one of the longest overland journeys in existence today, taking 7 days to reach Vladivostok from Moscow, and providing an alternative to air travel for journeys between Europe and Asia.

The Indian Pacific railway, completed in 1970, links Sydney and Perth in Australia. Covering 4,343km over 4 days, the railway includes the longest stretch of straight railway line in the world.

The introduction of Japan's high speed railway Tōkaidō Shinkansen in 1964 changed the face of rail travel. The railway has carried more than 4 billion passengers and its new N700 series trains are capable of 300 km/h. France's TGV holds the record for the fastest train, with a top speed of more than 500 km/h, making it faster than air travel for many journeys within the country.

Road Overland Travel

The Silk Route or Silk Road historically connects the Mediterranean with Persia and China. Today the route refers to overland journeys between Europe and China, taking either the northern route - through Russia and Kazakhstan - or the southern route - through Turkey, Iran, Pakistan and North India - to Urumqi or Xian in China. These routes are still popular today, with companies such as Oasis Overland and Odyssey Overland offering tours on the southern route.

Trans Africa Overland routes

Some of the longest and more traditional overland routes are in Africa. The Cairo to Cape Town and vice versa route covers more than 10,000km and currently usually follows the Nile River through Egypt and Sudan, continuing to Kenya, Tanzania, Malawi, Zimbabwe, Botswana and Namibia along the way. In 1959 the pioneering American trailer manufacturer Wally Byam and a caravan of trailers travelled the route from Cape Town to Cairo via Rhodesia (now Zimbabwe and Zambia), Belgian Congo (now Democratic Republic of Congo), Uganda and north from Kenya.

From the mid 1980s, the non-operation of the Aswan to Wadi Halfa ferry between Egypt and Sudan as well instability in Sudan, northern Uganda and Ethiopia, made the journey impossible. In recent years however, the Cape to Cairo and Cairo to Cape Town route has again become possible and increasingly popular both with commercial overland trucks carrying groups of 20 or so paying passengers as well as independent travelers on motorbikes or with 4WD (four wheel drive) vehicles.

The traditional Trans Africa route is from London to Nairobi, Kenya and Cape Town, South Africa. The route started in the 1970s and became very popular with small companies using old Bedford 4WD trucks carrying about 24 people each, plus lots of independents, normally run by groups of friends in 4x4 Land Rovers heading out of London from November to March every year. The usual route was from Morocco to Algeria with a Sahara desert crossing into Niger in West Africa, continuing to Nigeria.

This route has changed dramatically due to border closures and political instability creating no-go zones. The route has reversed itself somewhat over the last few years, with trucks now crossing from the north to the south of Africa, closely following the west coast all the way from Morocco to Cape Town with the biggest change in the route being made possible by the opening of Angola to tourism. The journey then continues through Southern and East Africa from Cape Town to Nairobi and on to Cairo.

The longest overland expedition of any kind is run by African Trails their London-Capetown-Istanbul journey (43 weeks) remains the classic overland expedition for die-hard travelers. Though the longest combination of trips is 50.5 weeks run by Dragoman from Helsinki, Finland to Cape Town, South Africa via Russia, China, Middle East, following the Nile and to Kenya and on to southern Africa.

Other overland routes

In Africa, commercial overland travel began with the Trans Africa and Cape to Cairo described above. From the mid 1980s East and Southern Africa became more sought after by tourists and Nairobi to Cape Town is now the most travelled overland route in Africa. As more tourists look for adventure trips that fit in to their annual holiday, shorter sections of overland routes have become available such as two to three week round trip from Nairobi taking in Kenya and Uganda.

Istanbul to Cairo, via Syria and Jordan, is a classic overland route. It is a route that has been travelled for centuries, particularly during the Ottoman Empire. Historically it overlapped with the Hajj, with many people covering all or part of the route as part of their pilgrimage to Mecca. Backpackers discovered it in the '70s and '80s, with hippies searching for spiritual peace who departed to Jerusalem from Istanbul instead of going to India via Iran, Afghanistan and Pakistan. After the peace treaty between Egypt and Israel, onward travel from Jerusalem to Cairo became a possibility. It is now well travelled by backpackers and overland companies alike although the amount of travelers journeying the route can be affected by any unrest in neighboring countries.

Pop-culture tourism is the act of traveling to locations featured in literature, film, music, or any other form of popular entertainment.

Popular destinations include:

• Los Angeles, California film studios;

• New Zealand after The Lord of the Rings was filmed there;

• Japan for japanophiles or lovers of Japanese pop-culture;

• North Bend, Washington and in particular Twede's Cafe where much of the television show Twin Peaks was shot;

• Tunisia, location of the filming of the Star Wars movies;

• Burkittsville, Maryland, where tourists re-create the most gruesome scenes from The Blair Witch Project.

Pop-culture tourism is in some respects akin to pilgrimage, with its modern equivalents of places of pilgrimage, such as Elvis Presley's Graceland and the grave of Jim Morrison in Père Lachaise Cemetery.

Poverty tourism or poorism, also known as township tourism or slumming is a type of tourism, in which tourists travel to less developed places to observe people living in poverty. Poorism travel tours are popular in places like India, Ethiopia, and even places that have had natural disasters such as hurricanes and tsunamis. After Hurricane Katrina, Louisiana became a big poorism site.

Slumming (derived from slum) originally referred to a practice, fashionable among certain segments of the middle class in many Western countries, whereby one deliberately patronizes areas or establishments which are populated by, or intended for, people well below one's own socio-economic level, motivated by curiosity or a desire for adventure. Most often these establishments take the form of bars or restaurants in low-income areas.

Recreational slumming was popular in Victorian London, where omnibus rides through Whitechapel were in vogue. Similarly, slumming tours were documented through the Five Points slums in Manhattan during the 1840s.

It's also associated with the middle 1980s, as an outgrowth of the yuppie subculture. The sense that upper-class establishments were phony, overpriced, and affected made it fashionable among middle-class professionals to frequent "dives", due to their supposed authenticity and local color.

"Slumming" (also known as "class tourism") has come to refer to many activities that involve interaction with the less fortunate, especially when motivated by curiosity, adventure, laziness, boredom, and even outright greed and miserliness.

Township tourism is a term used to describe a form of tourism that emerged in post-apartheid South Africa and Namibia. South African settlements are still visibly divided into wealthy, historically white suburbs and poor, historically black townships, because of the effects of apartheid and racial segregation. Before 1994 it was rare for tourists to visit townships. Increasingly the established South African tourism industry sees the townships as a resource for attracting tourism revenue. Smaller operations, including many emerging black tourism operators, see township tourism as a means of empowerment and of bolstering the self-esteem of people in these historically marginalized communities. Although township tours vary in form, they often differ from other tourism experiences in being interactive, socially minded, and potentially empowering for the communities involved. However they have also courted controversy, because of fears that they misrepresent South African culture.